The Pinocchio Effect

An interesting editorial published a couple of months ago in Anaesthesia by Neil Soni. It adds to the growing disquiet that our understanding of disease, and attempts to find effective remedies, are being hampered by the tendency to treat all organ failures equally. I agree that there seems little reason to believe that meningococal sepsis in an 18 year old will behave the same as peritonitis in an 80 year old, nor that ARDS following pancreatitis is the same as that following FFP. However, these syndromes were designed partly to make research into rare presentations possible. If we define patients according to causative factor and co-morbidity how are we ever to recruit enough to power even the most basic trial ?

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[…] Are our attempts to find effective remedies, being hampered by the tendency to treat all organ failures equally? This is just one of the question asked in an excellent post, looking at The Pinocchio Effect. […]

The Pinochio effect – trials on even well defined disease entities stratified for age and severity will become even more difficult when genetic polymorphism needs to be taken into account. Look at the paper by Lord darzi in this weeks NEJM if you’re intetrested